Table of ContentsView AllTable of ContentsWhat Is a Migraine?Secondary Vascular HeadachesWhen to See a ProviderFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is a Migraine?
Secondary Vascular Headaches
When to See a Provider
Frequently Asked Questions
Now an outdated term, “vascular headache” was used in the past to describe a migraine headache. Experts believed that the throbbing sensation of a migraine headache was due to mechanical changes within blood vessels that surrounded the head.
Over the past couple of decades, the thought process about the biology of a migraine attack has shifted from a vascular to a neural one.
Specifically, research now suggests that migraine headaches stem from an imbalance of brain chemicals and nerve-related problems. Any blood vessel changes that occur with a migraine are viewed as a secondary effect and not sufficient enough on their own to cause a headache.
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This article provides an overview of the diagnosis and treatment of both migraine headaches and secondary vascular headaches. It also reviews when you should see a healthcare provider for your headache.
Migraine
Thetrigeminal nerveis the largest of the12 cranial nerves. During a migraine, its nerve fibers release substances that irritate and cause swelling of the brain’s blood vessels.
Besides a headache, some people also experience other phases during a migraine attack. These phases include:
Migraine TriggersCommonly reported triggers of a migraine include hormonal changes, certain foods, weather, stress, alcohol, skipping meals, and sleep disturbances.
Migraine Triggers
Commonly reported triggers of a migraine include hormonal changes, certain foods, weather, stress, alcohol, skipping meals, and sleep disturbances.
Diagnosis
Your healthcare provider will review the characteristics of your headache (e.g., location, quality, and severity) and ask you whether you have any other symptoms like nausea, light sensitivity, or facial sweating. They will also review triggers and your family history.
For patients with suspected migraine headaches, imaging of the brain is not generally indicated unless worrisome features are present or there is something abnormal on theneurological exam.
Treatment
The treatment of migraine headaches includes lifestyle modifications, medication, or a combination. Preventive strategies like avoiding triggers or taking medication are used to decrease the number and severity of headache attacks.
Mild to moderate migraine headaches can be treated with anonsteroidal anti-inflammatory drug (NSAID)like Advil (ibuprofen) or Aleve (naproxen sodium), while more severe headaches usually require atriptan, like Imitrex (sumatriptan), or a combination NSAID/triptan, like Treximet (sumatriptan and naproxen sodium).
For people with migraine headaches who cannot take or tolerate a triptan, a calcitonin gene-related peptide (CGRP) blocker, such asNurtec ODT (rimegepant), may be recommended.
What Are Secondary Vascular Headaches?
Secondary vascular headaches are usually throbbing or thunderclap in nature. They start suddenly and become severe quickly.
According to the International Headache Society, these headaches may arise from one of the following various blood vessel pathologies:
Secondary vascular headaches can be dangerous, even potentially life-threatening, and may mimic primary headache disorders, like migraine or cluster headache.
If a secondary vascular headache is ever suspected, an imaging test such as computed tomography (CT) of the brain ormagnetic resonance imaging (MRI)of the brain and its blood vessels will be performed.
Other tests that may be ordered to identify the cause of the headache include:
The treatment of a secondary vascular headache depends on the underlying diagnosis.
As an example, high doses ofcorticosteroidsare used to treat giant cell arteritis. More dangerous headaches like stroke require monitoring within a hospital, intravenous (IV) medications, and, sometimes, surgery.
When to Seek Medical Attention
Most headaches can be managed at home and are not a cause for alarm. In some cases, though, a headache may be the only clue that something serious is going on in your body.
Scenarios that warrant a visit or call to your healthcare provider include:
Seek Emergency Care
Go to your emergency room or call 911 if your headache:
Summary
“Vascular headache” is an outdated term previously used to describe migraines. Migraine attacks are now believed to originate primarily from nerve-related problems in the brain, not blood vessel changes.
While the term “vascular headache” is no longer used, secondary vascular headaches do exist. These are headaches that arise from a blood vessel problem in the head or neck, such as a stroke or blood vessel tear.
A Word From Verywell
Include things like the time of day your headaches occur, how long they last, their severity, and the symptoms you felt before, during, and after the headaches. It’s also a good idea to jot down your sleeping and eating schedules. This will help identify possible headache triggers.
Changes in blood flow in the brain, along with other chemical changes, may contribute to the development of a headache (most notably a migraine headache).
Brain swelling is a potentially life-threatening condition. It may arise from an injury to the head, a brain tumor, a brain infection, or a stroke. While a headache is a symptom of brain swelling, a headache itself does not cause the brain to swell.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mason BN, Russo AF.Vascular contributions to migraine: time to revisit?Front Cell Neurosci2018;12:233. doi:10.3389/fncel.2018.00233Headache Classification Committee of the International Headache Society (IHS).The international classification of headache disorders, 3rd edition.Cephalalgia.2018;38(1):1-211. doi:10.1177/0333102417738202Noseda R, Burstein R.Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain.Pain. 2013;154 Suppl 1:10.1016/j.pain.2013.07.021. doi:10.1016/j.pain.2013.07.021American Migraine Foundation.The timeline of a migraine attackMay A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang S-J.Cluster headache.Nat Rev Dis Primers. 2018;4(1):18006. doi:10.1038/nrdp.2018.6.Rizzoli P, Mullally W.Headache.Am J Med. 2018;131(1):17-24. doi:10.1016/j.amjmed.2017.09.005Lu J, Liu W, Zhao H.Headache in cerebrovascular diseases.Stroke and Vascular Neurology2020;5. doi:10.1136/svn-2020-000333Kapoor S.Headache attributed to cranial or cervical vascular disorders.Curr Pain Headache Rep.2013;17(5):334. doi:10.1007/s11916-013-0334-yRana AQ, Saeed U, Khan OA, Qureshi ARM, Paul D.Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.J Neurosci Rural Pract.2014;5(4):409–411. doi:10.4103/0976-3147.140005Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mason BN, Russo AF.Vascular contributions to migraine: time to revisit?Front Cell Neurosci2018;12:233. doi:10.3389/fncel.2018.00233Headache Classification Committee of the International Headache Society (IHS).The international classification of headache disorders, 3rd edition.Cephalalgia.2018;38(1):1-211. doi:10.1177/0333102417738202Noseda R, Burstein R.Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain.Pain. 2013;154 Suppl 1:10.1016/j.pain.2013.07.021. doi:10.1016/j.pain.2013.07.021American Migraine Foundation.The timeline of a migraine attackMay A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang S-J.Cluster headache.Nat Rev Dis Primers. 2018;4(1):18006. doi:10.1038/nrdp.2018.6.Rizzoli P, Mullally W.Headache.Am J Med. 2018;131(1):17-24. doi:10.1016/j.amjmed.2017.09.005Lu J, Liu W, Zhao H.Headache in cerebrovascular diseases.Stroke and Vascular Neurology2020;5. doi:10.1136/svn-2020-000333Kapoor S.Headache attributed to cranial or cervical vascular disorders.Curr Pain Headache Rep.2013;17(5):334. doi:10.1007/s11916-013-0334-yRana AQ, Saeed U, Khan OA, Qureshi ARM, Paul D.Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.J Neurosci Rural Pract.2014;5(4):409–411. doi:10.4103/0976-3147.140005Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mason BN, Russo AF.Vascular contributions to migraine: time to revisit?Front Cell Neurosci2018;12:233. doi:10.3389/fncel.2018.00233Headache Classification Committee of the International Headache Society (IHS).The international classification of headache disorders, 3rd edition.Cephalalgia.2018;38(1):1-211. doi:10.1177/0333102417738202Noseda R, Burstein R.Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain.Pain. 2013;154 Suppl 1:10.1016/j.pain.2013.07.021. doi:10.1016/j.pain.2013.07.021American Migraine Foundation.The timeline of a migraine attackMay A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang S-J.Cluster headache.Nat Rev Dis Primers. 2018;4(1):18006. doi:10.1038/nrdp.2018.6.Rizzoli P, Mullally W.Headache.Am J Med. 2018;131(1):17-24. doi:10.1016/j.amjmed.2017.09.005Lu J, Liu W, Zhao H.Headache in cerebrovascular diseases.Stroke and Vascular Neurology2020;5. doi:10.1136/svn-2020-000333Kapoor S.Headache attributed to cranial or cervical vascular disorders.Curr Pain Headache Rep.2013;17(5):334. doi:10.1007/s11916-013-0334-yRana AQ, Saeed U, Khan OA, Qureshi ARM, Paul D.Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.J Neurosci Rural Pract.2014;5(4):409–411. doi:10.4103/0976-3147.140005Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
Mason BN, Russo AF.Vascular contributions to migraine: time to revisit?Front Cell Neurosci2018;12:233. doi:10.3389/fncel.2018.00233
Headache Classification Committee of the International Headache Society (IHS).The international classification of headache disorders, 3rd edition.Cephalalgia.2018;38(1):1-211. doi:10.1177/0333102417738202
Noseda R, Burstein R.Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain.Pain. 2013;154 Suppl 1:10.1016/j.pain.2013.07.021. doi:10.1016/j.pain.2013.07.021
American Migraine Foundation.The timeline of a migraine attack
May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang S-J.Cluster headache.Nat Rev Dis Primers. 2018;4(1):18006. doi:10.1038/nrdp.2018.6.
Rizzoli P, Mullally W.Headache.Am J Med. 2018;131(1):17-24. doi:10.1016/j.amjmed.2017.09.005
Lu J, Liu W, Zhao H.Headache in cerebrovascular diseases.Stroke and Vascular Neurology2020;5. doi:10.1136/svn-2020-000333
Kapoor S.Headache attributed to cranial or cervical vascular disorders.Curr Pain Headache Rep.2013;17(5):334. doi:10.1007/s11916-013-0334-y
Rana AQ, Saeed U, Khan OA, Qureshi ARM, Paul D.Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.J Neurosci Rural Pract.2014;5(4):409–411. doi:10.4103/0976-3147.140005
Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
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